Surgical Treatment of Mesiotemporal Lobe Epilepsy: Which Approach is Favorable?

Neurosurgery ◽  
2017 ◽  
Vol 81 (6) ◽  
pp. 992-1004 ◽  
Author(s):  
Barbara Schmeiser ◽  
Kathrin Wagner ◽  
Andreas Schulze-Bonhage ◽  
Irina Mader ◽  
Anne-Sophie Wendling ◽  
...  
Keyword(s):  
Verbal Memory ◽  
Postoperative Outcome ◽  
Temporal Lobectomy ◽  
Surgical Approaches ◽  
Seizure Outcome ◽  
Consecutive Series ◽  
Complication Rates ◽  
Pharmacoresistant Epilepsy ◽  
Anterior Temporal Lobectomy ◽  
Selective Amygdalohippocampectomy

Abstract BACKGROUND Mesiotemporal lobe epilepsy is one of the most frequent causes for pharmacoresistant epilepsy. Different surgical approaches to the mesiotemporal area are used. OBJECTIVE To analyze epileptological and neuropsychological results as well as complications of different surgical strategies. METHODS This retrospective study is based on a consecutive series of 458 patients all harboring pharmacoresistant mesiotemporal lobe epilepsy. Following procedures were performed: standard anterior temporal lobectomy, anterior temporal or key-hole resection, extended lesionectomy, and transsylvian and subtemporal selective amygdalohippocampectomy. Postoperative outcome was evaluated according to different surgical procedures. RESULTS Overall, 1 yr after surgery 315 of 432 patients (72.9%) were classified Engel I; in particular, 72.8% were seizure-free after anterior temporal lobectomy, 76.9% after key-hole resection, 84.4% after extended lesionectomy, 70.3% after transylvian selective amygdalohippocampectomy, and 59.1% after subtemporal selective amygdalohippocampectomy. No significant differences in seizure outcome were found between different resective procedures, neither in short-term nor long-term follow-up. There was no perioperative mortality. Permanent morbidity was encountered in 4.4%. There were no significant differences in complications between different resection types. In the majority of patients, selective attention improved following surgery. Patients after left-sided operations performed significantly worse regarding verbal memory as compared to right-sided procedures. However, surgical approach had no significant effect on memory outcome. CONCLUSION Different surgical approaches for mesiotemporal epilepsy analyzed resulted in similar epileptological, neuropsychological results, and complication rates. Therefore, the approach for the individual patient does not only depend on the specific localization of the epileptogenic area, but also on the experience of the surgeon.

Presence of Temporal Gray-White Matter Abnormalities Does Not Influence Epilepsy Surgery Outcome in Temporal Lobe Epilepsy With Hippocampal Sclerosis

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. 98-107 ◽  
Author(s):  
Olaf E M G. Schijns ◽  
Christian G. Bien ◽  
Michael. Majores ◽  
Marec. von Lehe ◽  
Horst. Urbach ◽  
...  
Keyword(s):  
White Matter ◽  
Temporal Lobe ◽  
Clinical Characteristics ◽  
Hippocampal Sclerosis ◽  
Temporal Lobectomy ◽  
Seizure Outcome ◽  
Anterior Temporal Lobectomy ◽  
Selective Amygdalohippocampectomy ◽  
Group 2 ◽  
Group 1

Abstract BACKGROUND: Temporal lobe gray-white matter abnormalities (GWMA) are frequent morphological aberrances observed on MRI in patients with temporal lobe epilepsy (TLE) in addition to hippocampal sclerosis (HS). OBJECTIVE: To study the influence of temporal pole GWMA on clinical characteristics and seizure outcome in patients with HS operated on for TLE. METHODS: A cohort of 370 patients undergoing surgery for intractable TLE was prospectively collected in an epilepsy surgery data base. Clinical characteristics and seizure outcome of all 58 TLE patients with identified HS and GWMA (group 1) were compared with those of a matched control group of 58 HS patients without GWMA (group 2). Both groups were further subdivided into patients undergoing transsylvian selective amygdalohippocampectomy (sAH) and anterior temporal lobectomy with amygdalohippocampectomy (ATL). RESULTS: The HS plus GWMA patients were significantly younger at epilepsy onset than those without GWMA. In the HS plus GWMA group, 41% of patients were younger than 2 years when they experienced their first seizure in contrast to only 17% of patients with pure HS (P = .004). Seizure outcome was not statistically different between the 2 groups: 75.9% of the patients in group 1 were seizure free (Engel class I) compared with 81% of patients in group 2. Seizure outcome in both groups was about equally successful with selective amygdalohippocampectomy and anterior temporal lobectomy (ns). CONCLUSION: Limited and standard resections in TLE patients with HS are equally successful regardless of the presence of GWMA.

Seizure outcomes and mesial resection volumes following selective amygdalohippocampectomy and temporal lobectomy

2012 ◽  
Vol 32 (3) ◽  
pp. E8 ◽  
Author(s):  
Oren Sagher ◽  
Jayesh P. Thawani ◽  
Arnold B. Etame ◽  
Diana M. Gomez-Hassan
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Test Scores ◽  
Memory Function ◽  
Mesial Temporal Lobe Epilepsy ◽  
Temporal Lobectomy ◽  
Surgical Approaches ◽  
Seizure Outcome ◽  
Selective Amygdalohippocampectomy ◽  
Significant Difference

Object Anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SelAH) are the preferred surgical approaches for the treatment of medically refractory epilepsy involving the nondominant and dominant temporal lobes, respectively. Both techniques provide access to mesial structures—with the ATL providing a wider surgical corridor than SelAH. Because the extent of mesial temporal resection potentially impacts seizure outcome, the authors examined mesial resection volumes, seizure outcomes, and neuropsychiatric test scores in patients undergoing either ATL or transcortical SelAH at a single institution. Methods A retrospective study was conducted in 96 patients with medically refractory mesial temporal lobe epilepsy. Fifty-one patients who had nondominant temporal lobe epilepsy underwent standard ATL, and 45 patients with language-dominant temporal lobe epilepsy underwent transcortical SelAH. Volumetric MRI analysis was used to quantify the mesial resection in both groups. In addition, the authors examined seizure outcomes and the change in neuropsychiatric test scores. Results Seizure-free outcome in the entire patient cohort was 94% at a mean follow-up of 44 months. There was no significant difference in the seizure outcome between the 2 groups. The extent of resection of the mesial structures following ATL was slightly higher than for SelAH (98% vs 91%, p < 0.0001). The change in neuropsychiatric test scores largely reflected the side of surgery, but overall IQ and memory function did not change significantly in either group. Conclusions Transcortical SelAH provides adequate access to the mesial structures, and allows for a resection that is nearly as extensive as that achieved with standard ATL. Seizure outcomes and neuropsychiatric sequelae are similar in both procedures.

scholarly journals Seizure outcome in pediatric medically refractory temporal lobe epilepsy surgery: selective amygdalohippocampectomy versus anterior temporal lobectomy

2018 ◽  
Vol 22 (3) ◽  
pp. 276-282 ◽  
Author(s):  
Cameron A. Elliott ◽  
Andrew Broad ◽  
Karl Narvacan ◽  
Trevor A. Steve ◽  
Thomas Snyder ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Pediatric Patients ◽  
Temporal Lobectomy ◽  
Seizure Outcome ◽  
Anterior Temporal Lobectomy ◽  
Selective Amygdalohippocampectomy ◽  
Significant Difference

OBJECTIVEThe aim of this study was to investigate long-term seizure outcome, rate of reoperation, and postoperative neuropsychological performance following selective amygdalohippocampectomy (SelAH) or anterior temporal lobectomy (ATL) in pediatric patients with medically refractory temporal lobe epilepsy (TLE).METHODSThe authors performed a retrospective review of cases of medically refractory pediatric TLE treated initially with either SelAH or ATL. Standardized pre- and postoperative evaluation included seizure charting, surface and long-term video-electroencephalography, 1.5-T MRI, and neuropsychological testing.RESULTSA total of 79 patients treated initially with SelAH (n = 18) or ATL (n = 61) were included in this study, with a mean follow-up of 5.3 ± 4 years (range 1–16 years). The patients’ average age at initial surgery was 10.6 ± 5 years, with an average surgical delay of 5.7 ± 4 years between seizure onset and surgery. Seizure freedom (Engel I) following the initial operation was significantly more likely following ATL (47/61, 77%) than SelAH (8/18, 44%; p = 0.017, Fisher’s exact test). There was no statistically significant difference in the proportion of patients with postoperative neuropsychological deficits following SelAH (8/18, 44%) or ATL (21/61, 34%). However, reoperation was significantly more likely following SelAH (8/18, 44%) than after ATL (7/61, 11%; p = 0.004) and was more likely to result in Engel I outcome for ATL after failed SelAH (7/8, 88%) than for posterior extension after failed ATL (1/7, 14%; p = 0.01). Reoperation was well tolerated without significant neuropsychological deterioration. Ultimately, including 15 reoperations, 58 of 79 (73%) patients were free from disabling seizures at the most recent follow-up.CONCLUSIONSSelAH among pediatric patients with medically refractory unilateral TLE yields significantly worse rates of seizure control compared with ATL. Reoperation is significantly more likely following SelAH, is not associated with incremental neuropsychological deterioration, and frequently results in freedom from disabling seizures. These results are significant in that they argue against using SelAH for pediatric TLE surgery.

Memory outcome after temporal lobe epilepsy surgery: corticoamygdalohippocampectomy versus selective amygdalohippocampectomy

2010 ◽  
Vol 113 (6) ◽  
pp. 1164-1175 ◽  
Author(s):  
Taner Tanriverdi ◽  
Roy William Roland Dudley ◽  
Alya Hasan ◽  
Ahmed Al Jishi ◽  
Qasim Al Hinai ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Verbal Memory ◽  
Hippocampal Sclerosis ◽  
Surgical Approaches ◽  
Seizure Outcome ◽  
Nonverbal Memory ◽  
Selective Amygdalohippocampectomy ◽  
Significant Difference

Object The aim of this study was to compare IQ and memory outcomes at the 1-year follow-up in patients with medically refractory mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis. All patients were treated using a corticoamygdalohippocampectomy (CAH) or a selective amygdalohippocampectomy (SelAH). Methods The data of 256 patients who underwent surgery for MTLE were retrospectively evaluated. One hundred twenty-three patients underwent a CAH (63 [right side] and 60 [left side]), and 133 underwent an SelAH (61 [right side] and 72 [left side]). A comprehensive neuropsychological test battery was assessed before and 1 year after surgery, and the results were compared between the surgical procedures. Furthermore, seizure outcome was compared using the Engel classification scheme. Results At 1-year follow-up, there was no statistically significant difference between the surgical approaches with respect to seizure outcome. Overall, IQ scores showed improvement, but verbal IQ decreased after left SelAH. Verbal memory impairment was seen after left-sided resections especially in cases of SelAH, and nonverbal memory decreased after right-sided resection, especially for CAH. Left-sided resections produced some improvement in nonverbal memory. Older age at surgery, longer duration of seizures, greater seizure frequency before surgery, and poor seizure control after surgery were associated with poorer memory. Conclusions Both CAH and SelAH can lead to several cognitive impairments depending on the side of the surgery. The authors suggest that the optimal type of surgical approach should be decided on a case-by-case basis.

scholarly journals Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

2015 ◽  
Vol 74 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Fábio A. Nascimento ◽  
Luana Antunes Maranha Gatto ◽  
Carlos Silvado ◽  
Maria Joana Mäder-Joaquim ◽  
Marlus Sidney Moro ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Anterior Temporal Lobectomy ◽  
Selective Amygdalohippocampectomy ◽  
Significant Difference ◽  
Mesial Temporal Lobe ◽  
Neuropsychological Outcomes

ABSTRACT Objective To contribute our experience with surgical treatment of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH). Method This is a retrospective observational study. The sample included patients with medically refractory mTLE due to unilateral mesial temporal sclerosis who underwent either ATL or SelAH, at Hospital de Clinicas – UFPR, from 2005 to 2012. We report seizure outcomes, using Engel classification, cognitive outcomes, using measurements of verbal and visuospatial memories, as well as operative complications. Result Sixty-seven patients (33 ATL, 34 SelAH) were studied; median follow-up was 64 months. There was no statistically significant difference in seizure or neuropsychological outcomes, although verbal memory was more negatively affected in ATL operations on patients’ dominant hemispheres. Higher number of major complications was observed in the ATL group (p = 0.004). Conclusion Seizure and neuropsychological outcomes did not differ. ATL appeared to be associated with higher risk of complications.

Predicting verbal memory decline following anterior temporal lobectomy (ATL)

Neurology ◽  
2003 ◽  
Vol 60 (8) ◽  
pp. 1266-1273 ◽  
Author(s):  
E. Stroup ◽  
J. Langfitt ◽  
M. Berg ◽  
M. McDermott ◽  
W. Pilcher ◽  
...  
Keyword(s):  
Verbal Memory ◽  
Temporal Lobectomy ◽  
Anterior Temporal Lobectomy ◽  
Memory Decline

scholarly journals Characterization of postsurgical functional connectivity changes in temporal lobe epilepsy

2020 ◽  
Vol 133 (2) ◽  
pp. 392-402 ◽  
Author(s):  
Victoria L. Morgan ◽  
Baxter P. Rogers ◽  
Hernán F. J. González ◽  
Sarah E. Goodale ◽  
Dario J. Englot
Keyword(s):  
Functional Connectivity ◽  
Temporal Lobe ◽  
Network Connectivity ◽  
Temporal Lobectomy ◽  
Seizure Outcome ◽  
Seizure Recurrence ◽  
Female Age ◽  
Selective Amygdalohippocampectomy ◽  
The Brain

OBJECTIVESeizure outcome after mesial temporal lobe epilepsy (mTLE) surgery is complex and diverse, even across patients with homogeneous presurgical clinical profiles. The authors hypothesized that this is due in part to variations in network connectivity across the brain before and after surgery. Although presurgical network connectivity has been previously characterized in these patients, the objective of this study was to characterize presurgical to postsurgical functional network connectivity changes across the brain after mTLE surgery.METHODSTwenty patients with drug-refractory unilateral mTLE (5 left side, 10 female, age 39.3 ± 13.5 years) who underwent either selective amygdalohippocampectomy (n = 13) or temporal lobectomy (n = 7) were included in the study. Presurgical and postsurgical (36.6 ± 14.3 months after surgery) functional connectivity (FC) was measured with 3-T MRI and compared with findings in age-matched healthy controls (n = 44, 21 female, age 39.3 ± 14.3 years). Postsurgical connectivity changes were then related to seizure outcome, type of surgery, and presurgical disease parameters.RESULTSThe results demonstrated significant decreases of FC from control group values across the brain after surgery that were not present before surgery, including many contralateral hippocampal connections distal to the surgical site. Postsurgical impairment of contralateral precuneus to ipsilateral occipital connectivity was associated with seizure recurrence. Presurgical impairment of the contralateral precuneus to contralateral temporal lobe connectivity was associated with those who underwent selective amygdalohippocampectomy compared to those who had temporal lobectomy. Finally, changes in thalamic connectivity after surgery were linearly related to duration of epilepsy and frequency of consciousness-impairing seizures prior to surgery.CONCLUSIONSThe widespread contralateral hippocampal FC changes after surgery may be a reflection of an ongoing epileptogenic progression that has been altered by the surgery, rather than a direct result of the surgery itself. This network evolution may contribute to long-term seizure outcome. Therefore, the combination of presurgical network mapping with the understanding of the dynamic effects of surgery on the networks may ultimately be used to create predictors of the likelihood of long-term seizure recurrence in individual patients after mTLE surgery.

scholarly journals A-250 Evidence for Language and Memory Improvements Following Right Anterior Temporal Lobectomy in a Patient with Mixed Language Dominance

2020 ◽  
Vol 35 (6) ◽  
pp. 1045-1045
Author(s):  
Leonard S ◽  
Olsen E ◽  
Bradbury K
Keyword(s):  
Verbal Memory ◽  
Verbal Fluency ◽  
Verbal Learning ◽  
Temporal Lobectomy ◽  
Neuropsychological Evaluation ◽  
Language Abilities ◽  
Anterior Temporal Lobectomy ◽  
Language Dominance ◽  
Mixed Language ◽  
History Of

Abstract Objective Anterior temporal lobectomy (ATL) surgery for epilepsy is commonly associated with post-surgical impairments in memory and language abilities, specifically episodic memory and confrontational naming. Less is known regarding outcomes of patients with atypical language dominance. Method Casey is a 19 year-old, ambidextrous, male with a history of remote symptomatic medically intractable focal epilepsy secondary to right inferior temporal encephalomalacia. Casey underwent right anterior temporal lobectomy and resection of mesial structures including part of the hippocampus. Results Casey’s pre-surgical neuropsychological evaluation revealed overall intellectual functioning in the average range with relative strengths in perceptual reasoning skills and weaknesses in attention, executive control, confrontational naming, and verbal fluency. Casey’s pre-surgical cognitive profile and functional MRI were suggestive of bilateral language organization. At post-surgical evaluation, Casey demonstrated strong overall cognitive abilities, basic reading, visual–spatial skills, and visual memory, as well as notable improvements in his processing speed and visual-motor integration. He demonstrated significant improvement in verbal working memory, verbal fluency, and contextual verbal memory. Casey continued to show significant weaknesses in word finding, phonetic verbal fluency, and rote verbal learning and memory, and milder weaknesses in aspects of executive functioning. Casey continued to demonstrate mood difficulties. Conclusions The current case provides evidence of continued mild deficits in traditional dominant hemisphere skills including rote verbal memory and focal language abilities, in a patient with a history of mixed language dominance, following right hemisphere ATL surgery. This case further highlights the importance of pre-surgical neuropsychological evaluation and fMRI in patients undergoing right ATL surgery.

scholarly journals A-080 Prediction Model for Verbal Memory Decline in Different Epilepsy Surgery Procedures: Temporal Lobectomy vs. Amygdalohippocampectomy

2020 ◽  
Vol 35 (6) ◽  
pp. 872-872
Author(s):  
Hageboutros K ◽  
Bono A ◽  
Johnson-Markve B ◽  
Smith K ◽  
Lee G
Keyword(s):  
Prediction Model ◽  
Epilepsy Surgery ◽  
Verbal Memory ◽  
Memory Loss ◽  
Low Risk ◽  
Temporal Lobectomy ◽  
Moderate Risk ◽  
Memory Decline ◽  
Selective Amygdalohippocampectomy ◽  
Risk Patients

Abstract Objective Mathematical models predicting risk of verbal memory decline after resective epilepsy surgery have been developed for patients undergoing temporal lobectomies. This study was undertaken to determine if application of the Stroup memory loss prediction model was as accurate in foreseeing verbal memory decline after temporal lobectomy as in the less invasive selective amygdalohippocampectomy procedure. Method This retrospective study examined the verbal memory performances of 40 left temporal lobectomy (ATL), and 16 left subtemporal approach selective amygdalohippocampectomy (SA-H), patients before and after epilepsy surgery using word list learning (Rey Auditory-Verbal Learning Test, Buschke Selective Reminding Test) and story memory (WMS Logical Memory) tests. Patients were assigned to one of four groups using the Stroup multiple regression equation: Minimal Risk (61% risk). To classify memory decline in individual patients, a pre-to-post surgery decrease of &gt; 1 SD on at least one memory test constituted memory decline. Results The prediction model accurately classified 82% (9/11) of ATL, and 75% (3/4) of SA-H, High Risk patients. Verbal memory loss was higher among ATLs than SA-Hs in the Moderate Risk (87% vs. 18%) and Low Risk (71% vs. 0%) groups. Conclusion The Stroup verbal memory loss risk model under-predicted memory loss among temporal lobectomy patients (71% of Low Risk patients showed memory decline) and over-predicted memory loss among selective amygdalohippocampectomy patients (only 18% of Moderate Risk patients showed memory decline). Results should be considered preliminary due to methodological limitation including small Ns and unequal sample sizes.

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